Been reading for a few weeks, and let me start by saying: Thanks!
My situation: Active, athletic 60-year-old. Had biopsy 9/21 after PSA went up to 5.74 (8/21) from 5.3 (2/21). GS 3+4
4 of 12 cores positive, all on left side, peripheral zone.
2 are GS 6 (90% and 8%) and 2 are GS 3+4=7 (30% and 67%)
Bone scan clear, and so is CT scan.
I knew a fair amount about treatment because of my occupation. I knew surgery wasn't for me.
My urologist was very even-handed, talked about equal outcomes from RT and RP for people like me, and side effects; if anything, I could see he leaned away from surgery (at least, for me), which is the opposite of what I hear in the group here.
I wanted to pursue AS if possible, mostly because I wanted time to think this through, but knew treatment was probably inevitable. My urologist said that AS "isn't inappropriate" for me and was a "fair" decision. But I could tell he thought he'd probably be recommending treatment after my next PSA test in 3 months.
I went to MSKCC, met with an RO.
MSK analyzed bone scan and CT scan, which conformed with the original lab analysis.
Pathology at MSK is still analyzing biopsy slides; should have their analysis this week.
My RO said, based on the original biopsy analysis (but pending MSK's, which could change his advice), he advises against AS and recommends HDR brachy followed a month later by 5 sessions of SBRT. (Not a rush, he said, and could wait a couple of months, at least until after the holidays). This was a similar treatment combo that a couple of men I know had followed and I've seen it is a treatment combo among some here.
My urologist, having now consulted with my RO, completely supports the RO's plan.
I then had an MRI at MSK: PIRADS 4, high; 1 lesion, 1 cm; Prostate size: 4.6 x 3.1 x 4.0 cm; Prostate volume 29.7; No ECE. No seminal vesicle invasion.
I will meet with my RO next week, after the MSK analysis of the slides is complete and after he's reviewed the MRI, which appears to conform with the biopsy and other tests.
I have noticed that, among those I've connected with as well as men in this forum, there are a fair number in the 3+4 world getting brachy boost. But there are also a fair number doing monotherapy, mostly SBRT. I know the devil is in the details, re: what separates us in the 3+4 world.
Like everyone, I want to make the right decision for myself. The best curative option is important to me, but so is QOL. Mostly, I want to get treatment past me and get back out into my active life, hoping for few long-term issues and not having recurrence. I know -- everyone's dream here. Any opinions welcome. Thanks.